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COMPETENCY-BASED OCCUPATIONAL FRAMEWORK

COMPETENCY-BASED OCCUPATIONAL FRAMEWORK FOR REGISTERED APPRENTICESHIP

Surgical Technologist ONET Code: 29-2055.00

RAPIDS Code: 1051CB

Created: August 2018

Updated:

This project has been funded, either wholly or in part, with Federal funds from the Department of Labor,

Employment and Training Administration under Contract Number DOL-ETA-15-C-0087. The contents of this

publication do not necessarily reflect the views or policies of the Department of Labor, nor does mention of trade

names, commercial products, or organizations imply endorsement of the same by the U.S. Government.

For More Information, Contact:

Diana Elliott, PhD, Senior Research Associate, Urban Institute: [email protected]

Robert Lerman, PhD, Institute Fellow, Urban Institute: [email protected]

mailto:[email protected]

mailto:[email protected]

A B O U T T H E U R BA N I N S T I T U TE The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector.

Acknowledgments We are grateful to Rebecca Malberg von Loewenfeldt and Neelan Gupta of the Healthcare Career

Advancement Program (“H-CAP”) for their help with this document. We also thank the many

representatives of the health and medical field who contributed to this effort.

Anne Wetmore, MPA Wetmore & Associates, Wheaton, IL Lymus Capehart USDOL, Alaska Apprenticeship and Training Alaska Beth Safran-Mukai, HR Operations El Camino Mountain View, CA Brooke Williams, Surgical Technician El Camino Mountain View, CA Andrew Colley, Operating Room Manager Kaiser San Leandro, CA Steven Gomez, Operating Room Manager Kaiser Fremont, CA Mary Sandman, NCAL Talent Acquisition Leader, Allied Health – Service Line Manager Kaiser NCAL Region Oakland, CA Rebecca Miller, Workforce Director SEIU UHW-West San Francisco, CA

Bill Gilligan, Perioperative Director Dignity Health St. Mary’s, CA Sindy Rojas, Surgery Office Coordinator/Shop steward Dignity Health St. Mary’s, CA Tamara Stafford, Director of Talent Development El Camino Mountain View, CA Beth Willy, Director of Clinical Education El Camino Mountain View, CA Gustavo Garcia, Steward – Surg Tech Kaiser Fremont, CA Danielle Pollard, Workforce Planning Consultant Kaiser National Workforce Planning and Development Oakland, CA Era Sethi, Regional Recruitment Manager Kaiser NCAL Region San Leandro, CA Terrie Ridgway-Olmos, Regional Contract Specialist SEIU UHW-West South San Francisco, CA

Keni Addison, Implementation Specialist SEIU-UHW Joint Employer Education Fund Sacramento, CA Cindy Chambers, Consultant SEIU-UHW Joint Employer Education Fund Rebecca Hanson, Executive Director SEIU-UHW Joint Employer Education Fund Oakland, CA

Shani Byard, Director of Career Advancement SEIU-UHW Joint Employer Education Fund Los Angeles, CA Scott Goodell, Program Director SEIU-UHW Joint Employer Education Fund Los Angeles, CA Letitia Segura, Assistant Director, Upgrade SEIU-UHW Joint Employer Education Fund Los Angeles, CA

I V A C K N O W L E D G M E N T S

Contents Competency-Based Occupational Frameworks v

Components of the Competency-Based Occupational Framework vi Using the Competency-Based Occupational Framework to Develop a Registered Apprenticeship

Program vii

Surgical Technologist 8

Occupational Overview 8 Occupational Purpose and Context 8 Potential Job Titles 8 Attitudes and Behaviors 9 Apprenticeship Prerequisites 9 Occupational Pathways 9 Certifications, Licensure and Other Credential Requirements 10 Job Functions 10

Work Process Schedule 11 Related Technical Instruction Plan 14

Cross Cutting Competencies 17

Detailed Job Functions 19 JOB FUNCTION 1: Prepare for Surgical Procedures 19 JOB FUNCTION 2: Perform Intraoperative Duties/Activities 23 JOB FUNCTION 3: Perform Postoperative Procedures and Room Turnover 27 JOB FUNCTION 4: Assist Circulator 29 JOB FUNCTION 5: Recognize and Demonstrate Knowledge of the Maintenance of Surgical

Supplies/Equipment 30 JOB FUNCTION 6: Provide safe environment 32 JOB FUNCTION 7: Perform Departmental Responsibilities 34 JOB FUNCTION 8: Maintain Professional Responsibility 36

References 38

Statement of Independence 39

O V E R V I E W O F C O M P E T E N C Y - B A S E D O C C U P A T I O N A L F R A M E W O R K S V

Competency-Based Occupational Frameworks The Urban Institute, under contract by the U.S. Department of Labor, has worked with employers,

subject matter experts, labor unions, trade associations, credentialing organizations and academics to

develop Competency-Based Occupational Frameworks (CBOF) for Registered Apprenticeship

programs. These frameworks defined the purpose of an occupation, the job functions that are carried

out to fulfill that purpose, the competencies that enable the apprentice to execute those job functions

well, and the performance criteria that define the specific knowledge, skills and personal attributes

associated with high performance in the workplace. This organizational hierarchy – Job Purpose – Job

Functions – Competencies – Performance Criteria – is designed to illustrate that performing work well

requires more than just acquiring discrete knowledge elements or developing a series of manual skills.

To perform a job well, the employee must be able to assimilate knowledge and skills learned in various

settings, recall and apply that information to the present situation, and carry out work activities using

sound professional judgment, demonstrating an appropriate attitude or disposition, and achieving a

level of speed and accuracy necessary to meet the employer’s business need.

The table below compares the terminology of Functional Analysis with that of traditional Occupational

Task Analysis to illustrate the important similarities and differences. While both identify the key

technical elements of an occupation, Functional Analysis includes the identification of behaviors,

attributes and characteristics of workers necessary to meet an employer’s expectations.

Framework Terminology Traditional Task Analysis Terminology

Job Function – the work activities that are carried out to fulfill the job purpose

Job Duties – roles and responsibilities associated with an occupation

Competency – the actions an individual takes and the attitudes he/she displays to complete those activities

Task – a unit of work or set of activities needed to produce some result

Performance Criteria – the specific knowledge, skills, dispositions, attributes, speed and accuracy associated with meeting the employer’s expectations

Sub Task – the independent actions taken to perform a unit of work or a work activity

Although designed for use in competency-based apprenticeship, these Competency-Based

Occupational Frameworks also support time-based apprenticeship by defining more clearly and

precisely what an apprentice is expected to learn and do during the allocated time-period.

V I C O M P E T E N C Y - B A S E D O C C U P A T I O N A L F R A M E W O R K S

CBOFs are comprehensive to encompass the full range of jobs that may be performed by individuals in

the same occupation. As employers or sponsors develop their individual apprenticeship programs, they

can extract from or add to the framework to meet their unique organizational needs.

Components of the Competency-Based Occupational Framework

Occupational Overview: This section of the framework provides a description of the occupation

including its purpose, the setting in which the job is performed and unique features of the occupation.

Work Process Schedule: This section includes the job functions and competencies that would likely be

included in an apprenticeship sponsor’s application for registration. These frameworks provide a point

of reference that has already been vetted by industry leaders so sponsors can develop new programs

knowing that they will meet or exceed the consensus expectations of peers. Sponsors maintain the

ability to customize their programs to meet their unique needs, but omission of a significant number of

job functions or competencies should raise questions about whether or not the program has correctly

identified the occupation of interest.

Cross-cutting Competencies: These competencies are common among all workers, and focus on the

underlying knowledge, attitudes, personal attributes and interpersonal skills that are important

regardless of the occupation. That said, while these competencies are important to all occupations, the

relative importance of some versus others may change from one occupation to the next. These relative

differences are illustrated in this part of the CBOF and can be used to design pre-apprenticeship

programs or design effective screening tools when recruiting apprentices to the program.

Detailed Job Function Analysis: This portion of the framework includes considerable detail and is

designed to support curriculum designers and trainers in developing and administering the program.

There is considerable detail in this section, which may be confusing to those seeking a more succinct,

higher-level view of the program. For this reason, we recommend that the Work Process Schedule be

the focus of program planning activities, leaving the detailed job function analysis sections to

instructional designers as they engage in their development work.

a. Related Technical Instruction: Under each job function appears a list of foundational

knowledge, skills, tools and technologies that would likely be taught in the classroom to

enable the apprentice’s on-the-job training safety and success.

O V E R V I E W O F C O M P E T E N C Y - B A S E D O C C U P A T I O N A L F R A M E W O R K S V I I

b. Performance Criteria: Under each competency, we provide recommended performance

criteria that could be used to differentiate between minimally, moderately and highly

competent apprentices. These performance criteria are generally skills-based rather than

knowledge-based, but may also include dispositional and behavioral competencies.

Using the Competency-Based Occupational Framework to Develop a Registered

Apprenticeship Program

When developing a registered apprenticeship program, the Work Process Schedule included in this

CBOF provides an overview of the job functions and competencies an expert peer group deemed to be

important to this occupation. The Work Process Schedule in this document can be used directly, or

modified and used to describe your program content and design as part of your registration application.

When designing the curriculum to support the apprenticeship program – including on the job training

and related technical instruction – further information in Detailed Job Functions could be helpful.

These more detailed job function documents include recommendations for the key knowledge and skill

elements that might be included in the classroom instruction designed to support a given job function,

and the performance criteria provided under each competency could be helpful to trainers and mentors

in evaluating apprentice performance and insuring inter-rater reliability when multiple mentors are

involved.

8 W O R K P R O C E S S S C H E D U L E

Surgical Technologist

Occupational Overview

Occupational Purpose and Context

Surgical technologists work as members of a healthcare team alongside physicians and

surgeons, registered nurses, and other healthcare workers.

Before an operation, surgical technologists prepare the operating room by setting up surgical

instruments and equipment. They also prepare patients for surgery by washing and disinfecting incision

sites, positioning the patients on the operating table, covering them with sterile drapes, and taking them

to and from the operating room. Surgical technologists prepare sterile solutions and medications used

in surgery and check that all surgical equipment is working properly. They help the surgical team put on

sterile gowns and gloves.

During an operation, surgical technologists pass instruments and supplies to surgeons and first

assistants. They also hold retractors, hold internal organs in place during the procedure, or set up

robotic surgical equipment. Technologists also may handle specimens taken for laboratory analysis.

Once the operation is complete, surgical technologists may apply bandages and other dressings to the

incision site. They may also help transfer patients to recovery rooms and restock operating rooms after

a procedure.

Potential Job Titles

Surgical Technologist; Tech in Surgery – Certified; Certified Surgical Technologist; Operating Room

Technician

https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm

https://www.bls.gov/ooh/healthcare/registered-nurses.htm

W O R K P R O C E S S S C H E D U L E 9

Attitudes and Behaviors

Persons who are successful in becoming surgical technologists possess a strong sense of responsibility,

are able to anticipate and respond appropriately to perceived needs without being asked, and have

considerable patience and concern for others. Such persons function well in a team, perform accurately

and efficiently under pressure, and possess manual dexterity and fine motor coordination.

Other terms to describe attitudes and behaviors of surgical technologists include: Efficient, emotionally

stable, ethical, flexible, able to follow directions, honest, intuitive, organized, hygienic, physically fit, punctual,

receptive, reliable, respecting of patient privacy, responsible, possessing a sense of humor.

Apprenticeship Prerequisites

Surgical Technologists must complete post-secondary training (from a one year program to an

Associate’s Degree program) and/or have experience as a surgical assistant in a medical or military

setting. Surgical technology education programs include courses in anatomy, physiology, biology,

medical terminology, pharmacology and anesthesia, microbiology, pathophysiology, and often some

technological and other instruction. Previous certification as a surgical technologist, a set number of

years of experience as a surgical technologist, and/or military training and experience as a military

surgical technologist can qualify a person to take the certification exam for certification renewal,

depending on the type of certification. Participation in a training program requires a complete

background check, documentation of current required-immunizations and current Healthcare Provider

CPR certification.

Occupational Pathways

Some surgical technologists progress to become Surgical First Assistants. Surgical first assistants often

work as surgical technologists and receive additional on-the-job training before becoming first

assistants. Others may complete a formal education program in surgical assisting.

Surgical first assistants have a hands-on role, directly assisting surgeons during a procedure. For

instance, they may help to suction the incision site or suture a wound.

1 0 W O R K P R O C E S S S C H E D U L E

Certifications, Licensure and Other Credential Requirements

CREDENTIAL Offered By Before, During or After Apprenticeship

Certified Surgical Technologist (CST)

National Board of Surgical Technology and Surgical Assisting

Before

Tech in Surgery-Cerified: TS-C(NCCT)

National Center For Competency Testing Before or during

Job Functions

JOB FUNCTIONS Core or Optional

Level

1. Prepare for Surgical Procedures Core

2. Perform Intraoperative Duties/Activities Core

3. Perform Postoperative Procedures and Room Turnover Core

4. Assist Circulator Core

5. Recognize and Demonstrate Knowledge of the Maintenance of Surgical Supplies/Equipment

Core

6. Provide Safe Environment Core

7. Perform Departmental Responsibilities Core

8. Maintain Professional Responsibility Core

W O R K P R O C E S S S C H E D U L E 1 1

Work Process Schedule WORK PROCESS SCHEDULE

Surgical Technologist

ONET Code: 29-2055.00

RAPIDS Code: 1051CB

JOB TITLE: Surgical Technologist

Company Contact: Name

Address:

Phone Email

Apprenticeship Type:

___X__Competency-Based

_______Time-Based _______Hybrid

Prerequisites

1-year accreditation program or Associate’s Degree

Background Check

Documentation of Immunizations

Current Healthcare Provider CPR certification

JOB FUNCTION 1: Prepare for Surgical Procedures

Competencies Core or RTI OJT

A. Prepare the operating room environment according to the surgical procedure

Core

B. Prepare for the specific procedure Core

C. Establish sterile field Core

D. Take preoperative precautions Core

E. Prepare the patient and surgical team Core

F. Participate in surgical time out Core


JOB FUNCTION 2: Perform Intraoperative Duties/Activities

Competencies Core or Optional

OJT RTI

A. Maintain the operating room environment according to surgical procedure

Core

B. Provide the surgical team members with supplies required for the procedure

Core

C. Assemble and test materials and specialty equipment during surgery

Core

D. Anticipate needs during surgery Core

E. Provide intraoperative assistance when delegated by a surgeon

Core

F. Handle medications, solutions, and specimens appropriately Core

G. Perform closing sponge, needle, and instrument counts Core

JOB FUNCTION 3: Perform Postoperative Procedures and Room Turnover


OJT RTI

A. Conduct postoperative patient care Core

B. Dispose of waste Core

C. Conduct room turnover after surgery Core

JOB FUNCTION 4: Assist Circulator


OJT RTI

A. Assist with/provide patient care Core

B. Assist with supplies and equipment Core

JOB FUNCTION 5: Recognize and Demonstrate Knowledge of the Maintenance of Surgical Supplies/Equipment


OJT RTI

A. Wash and decontaminate instruments Core

B. Ultrasound, milk, rinse and dry instruments Core


C. Assemble instrument trays Core

D. Prepare for and operate sterilizers Core

JOB FUNCTION 6: Provide Safe Environment


OJT RTI

A. Maintain a safe preoperative environment Core

B. Maintain a safe intraoperative environment Core

C. Maintain a safe postoperative environment Core

D. Practice precautions with critical equipment Core

E. Practice general safety precautions Core

JOB FUNCTION 7: Perform Departmental Responsibilities


OJT RTI

A. Receive/participate in dept. communications Core

B. Inventory supplies Core

C. Rotate supplies Core

D. Order supplies Core

E. Create/update surgeon preference cards Core

F. Attend inter/intra departmental committees Core

G. Maintain cleanliness of department Core

JOB FUNCTION 8: Maintain Professional Responsibility

Competencies Core OJT RTI

A. Maintain institutional competencies Core

B. Practice cost containment Optional

C. Attend/contribute to in-service classes Core

D. Evaluate new equipment Optional

E. Precept new employees/students Core

F. Participate in performance improvement activities Core


Related Technical Instruction Plan

Note: Accredited instruction plans for surgical technologists vary across training institutions. The plan

described below is an example of coursework required for a basic degree in Surgical Technology. Other

plans, especially those for an Associate Degree in Surgical Technology, can include additional core

curricula.

COURSE NAME: GENERAL ANATOMY AND PHYSIOLOGY

Course Number

Hours: 60 total

LEARNING OBJECTIVES

General Anatomy and Physiology examines basic concepts of human anatomy and physiology as they relate to health sciences. Using a body systems approach, the course emphasizes the interrelationships between structure and function at the gross and microscopic levels of organization, of the entire human body. It is intended to prepare health care professionals who need to apply basic concepts of whole body anatomy and physiology to informed decision-making and professional communication with colleagues and patients.

COURSE NAME: MEDICAL TERMINOLOGY

Course Number

Hours: 45 total

LEARNING OBJECTIVES

Medical Terminology focuses on the component parts of medical terms: prefixes, suffixes and word roots. Students practice formation, analysis and reconstruction of terms. Emphasis is on spelling, definition and pronunciation. Introduction to operative, diagnostic, therapeutic and symptomatic terminology of all body systems, as well as systemic and surgical terminology, is included.

COURSE NAME: WRITTEN COMMUNICATION

Course Number

Hours: 45 total

LEARNING OBJECTIVES

Written Communication develops writing skills which include prewriting, drafting, revising, and editing. A variety of writing assignments is designed to help the learner analyze audience and purpose, research and organize ideas, and format and design documents based on subject matter and content. Written Communication also develops critical reading and thinking skills through the analysis of a variety of written documents.


COURSE NAME: SURGICAL TECHNOLOGIST FUNCTIONAL MICROBIOLOGY

Course Number

Hours: 15 Total

LEARNING OBJECTIVES

Surgical Technologist Functional Microbiology introduces general classification, structure and physiology of microorganisms. Students learn the relationship between microorganisms and the human host as well as microbes in the hospital environment. Examines the study of the disease process, transmission of disease and methods of controlling microbial growth.

COURSE NAME: SURGICAL TECHNOLOGY INTRODUCTION

Course Number

Hours: 60 total

LEARNING OBJECTIVES

Surgical Technology Introduction provides the foundational knowledge of infection control and asepsis. Legal and ethical issues encountered in the healthcare environment are explored. Simulated laboratory practice enables the learner to develop beginning technical skills

COURSE NAME: SURGICAL TECHNOLOGY FUNDAMENTALS

Course Number

Hours: 90 Total

LEARNING OBJECTIVES

Surgical Technology Fundamentals includes the basic clinical skills needed by the Surgical Technologist in the scrub role. Learners develop skills in identifying basic instrumentation, supplies, drains, catheters, dressings and sponges. Includes practice experience in creating a sterile field, draping, passing instruments and supplies, performing counts and preparing supplies. Builds upon and reinforces the role of the Surgical Technologist as a member of the operating room team. Discusses care of the patient before, during and after surgery with emphasis on surgical wounds, wound closure materials, and vital signs.

COURSE NAME: SURGICAL TECHNOLOGY SURGICAL PROCEDURES

Course Number

Hours: 60 Total

LEARNING OBJECTIVES

Surgical Technology Surgical Procedures provides the foundational knowledge of surgical core and specialty procedures. Examines the pathophysiology, diagnostic interventions and surgical interventions for a variety of surgical procedures. Incorporates integration of basic health sciences and technical knowledge to complete a plan of action for a surgical procedure.


COURSE NAME: SURGICAL TECHNOLOGY CLINICAL

Course Number

Hours: 165 Total

LEARNING OBJECTIVES

In Surgical Technology Clinical, students will apply basic surgical theories, principles, and procedural techniques in the operating room. Students begin to function as team members under the guidance of the instructor and authorized clinical personnel. Surgical rotation case requirements are documented. Further experience in a clinical setting allows the student to continue to improve technical skills while accepting more responsibilities during surgical procedures. Enhances the student's technical experience and employee skills. Serves as a transition between student and employee. Application of advanced skills for the entry-level Surgical Technologies in the clinical setting.

C R O S S - C U T T I N G C O M P E T E N C I E S 1 7

Cross Cutting Competencies COMPETENCY** 0 1 2 3 4 5 6 7 8

Per

son

al E

ffec

tive

nes

s

Interpersonal Skills

Integrity

Professionalism

Initiative

Dependability and Reliability

Adaptability and Flexibility

Lifelong Learning

Aca

dem

ic

Reading

Writing

Mathematics

Science & Technology

Communication

Critical and Analytical Thinking

Basic Computer Skills

Wo

rkp

lace

Teamwork

Customer Focus

Planning and Organization

Creative Thinking

Problem Solving & Decision Making

Working with Tools & Technology

Checking, Examining & Recording

Business Fundamentals

Sustainable

Health & Safety

**Cross-Cutting Competencies are defined in the Competency Model Clearinghouse:

https://www.careeronestop.org/CompetencyModel/competency-models/buidling-blocks-model.aspx.

https://www.careeronestop.org/CompetencyModel/competency-models/buidling-blocks-model.aspx

1 8 C R O S S - C U T T I N G C O M P E T E N C I E S

Cross-Cutting Competencies identify transferable skills – sometimes called “soft skills” or

“employability skills” – that are important for workplace success, regardless of a person’s occupation.

Still, the relative importance of specific Cross-Cutting Competencies differs from occupation to

occupation. The Cross-Cutting Competencies table, above, provides information about which of these

competencies is most important to be successful in a particular occupation. This information can be

useful to employers or intermediaries in screening and selecting candidates for apprenticeship

programs, or to pre-apprenticeship providers that seek to prepare individuals for successful entry into

an apprenticeship program.

The names of the Cross-Cutting Competencies come from the U.S. Department of Labor’s Competency

Model Clearinghouse and definitions for each can be viewed at

https://www.careeronestop.org/CompetencyModel/competency-models/building-blocks-model.aspx.

The scoring system utilized to evaluate the level of competency required in each cross cutting skill

aligns with the recommendations of the Lumina Foundation’s Connecting Credentials Framework. The

framework can be found at: http://connectingcredentials.org/wp-

content/uploads/2015/05/Connectingtials-4-29-30.pdf.

S U R G I C A L T E C H N O L O G I S T 1 9

Detailed Job Functions

JOB FUNCTION 1: Prepare for Surgical Procedures

Related Technical Instruction

KNOWLEDGE* SKILLS* TOOLS & TECHNOLOGIES*

Assessing and planning for age-related needs of the patient Biopsychosocial needs of the patient Basic Math/Metric System Conversion Compressed Gases and Regulators Medical terminology Anatomy and Physiology Pharmacology and Anesthesia Pathophysiology Microbiology Electricity Robotics

Aseptic technique Communication skills Mechanical skills Organizational skills (preoperative case management) Obtaining blood from blood bank upon request Donning OR attire Basic Handwash Opening and arranging sterile supplies and instruments Surgical scrub Gowning and gloving self Arranging and cutting sutures and ties Drawing up and labeling medications Gowning and gloving others Draping patient

Air Filtration Systems Anesthesia Machines/Monitors Auto-transfusion units. Blood recovery and delivery systems Catheters/Drains Collection Bags/Devices Coronary Bypass Pumps Crash Carts (Defibrillators) Cryo Units Doppler Ultrasound Units Drapes and Packs Dressings (2X2, 4X4, ABD, AG(?), Bio-adhesive, Non-adhesive, Cast, Eye-Pad, Gauze, Liquid, Packing, Peri-Pad, Tapes) Drugs and Solutions (Antibiotics, Anticoagulants, Antiseptics, Disinfectants, Dyes, Hemostatic Agents, Irrigation Solutions, Local Anesthetics, Radioactive Materials, Steroids, Topical Ointments, Vasodilator/Constrictors) (lights, headlights, spotlights, loupes) (“free”, blunt, cutting, taper, trocar) Positioning Equipment (ethylene oxide sterilizers, sterad machines) Electronic/mercury blood pressure units Electrosurgical or electrocautery equipment (argon beam coagulators, electrocautery equipment, spark-gap electrosurgical units, thermal cautery units) Endoscopic video cameras/adapters/accessories/systems Eyemagnets for ophthalmic surgery Flash autoclaves Fracture tables Gloves Gowns Hypo/Hyper-thermia units Implants Insufflators Irrigation pumps

2 0 D E T A I L E D J O B F U N C T I O N S

Laparoscopes, laparoscopic telescopes, lap mayo trays or mayo stands Lasers (Argon, CO2, Holmium, KTP) Light sources Masks Medical cine fluoroscopy equipment Microscopes Needles OR Furniture Ring stands and positioning Equipment Robotic manipulators/surgical navigation systems Smoke Evacuators Sponges (4X4, cottonoid, dental roll, eye sponge, Kitner, Laps, swabs, tonsil sponge) Stretchers Sterilizers Steri-vac aeration cabinets Suction Surgical dermatomes or dermameshers and accessories Surgical Instruments (clamps, cutting, dissectors/elevators, endoscopes, forceps, graspers, needleholders, power equipment, probes/dilators, retractors, suction tips) Surgical nerve stimulators and accessories Surgical pneumatic or battery or electric saws or drills or pin drivers or accessories (craniotome drills, neurotome drills, orthopedic drills, surgical pneumatic drills) Pneumatic tourniquets Surgical power equipment sets or accessories (robotic arms, surgical robotics equipment, voice activated surgical systems) Surgical scalpels, knives, blades, trephines, or accessories Sutures (absorbable, non-absorbable, staples, steri-strips) Therapeutic healing or cooling blankets or drapes Tourniquets Trach Tube Ultrasound Video/cameras, recorders, printers Vascular sequential compression devices or tubing (venodynes) Vein harvest kits or systems (endoscopic vein harvesting equipment) X-ray fluoroscopy

* Detailed descriptions are available online from the Association for Surgical Technologists (2011) and the National Center for Competency Testing (2017).


Core or Optional

Competency A: Prepare the operating room environment according to the surgical procedure

PERFORMANCE CRITERIA

1. Identify supplies and equipment needed for the procedure Core

2. Identify furniture needed in the room Core

3. Assemble supplies and equipment in the room Core

4. Verify the presence of surgical team members and patient Core

5. Anticipate the needs of special patient populations Core

Competency B: Prepare for the specific procedure


1. Gather specific surgical supplies, medications, and equipment based on the surgeon’s preference card

Core

2. Check package integrity and expiration date of sterile supplies Core

3. Obtain specialized patient equipment Core

4. Perform urinary catheterization Core

5. Perform skin preparation Core

6. Assemble and test positioning equipment Core

7. Don personal protective equipment Core

Competency C: Establish sterile field


1. Follow principles of sterile technique while opening supplies for the surgery Core

2. Perform surgical hand scrub Core

3. Don sterile gown and gloves Core

4. Set up and inspect sterile instruments and supplies for surgical procedures Core

Competency D: Take preoperative precautions


1. Perform preoperative count with the circulating nurse Core

2. Verify identity of the patient and operative site Core


3. Verify and label medications and solutions at the sterile field Core

Competency E: Prepare the patient and surgical team


1. Transfer patient to the operating room table Core

2. Place safety belt and pressure pads on the patient Core

3. Assist surgical team with gloving and gowning Core

4. Assist with draping the patient Core

Competency F: Participate in surgical time out


1. Confirm names and roles of all team members Core

2. Confirm patient identity, surgical site, and procedure Core

3. Participate in review of anticipated critical events Core

4. Confirm equipment availability and sterility Core


JOB FUNCTION 2: Perform Intraoperative Duties/Activities


KNOWLEDGE* SKILLS* TOOLS & TECHNOLOGIES*

Assessing and planning for age-related needs of the patient Basic Math/Metric System Conversion Compressed Gases and Regulators Medical terminology Anatomy and Physiology Pharmacology and Anesthesia Pathophysiology Microbiology Electricity Robotics Tissue replacement materials

Aseptic technique Communication skills Mechanical skills Specimen care Incisions Use of catheters and drains Wound closure Surgical dressings Loading and passing needles Tagging and cutting sutures Passing ties Re-gloving and re-gowning

Air Filtration Systems Anesthesia Machines/Monitors Auto-transfusion units. Blood recovery and delivery systems Catheters/Drains Collection Bags/Devices Coronary Bypass Pumps Crash Carts (Defibrillators) Cryo Units Doppler Ultrasound Units Drapes and Packs Dressings Drugs and Solutions (Antibiotics, Anticoagulants, Antiseptics, Disinfectants, Dyes, Hemostatic Agents, Irrigation Solutions, Local Anesthetics, Radioactive Materials, Steroids, Topical Ointments, Vasodilator/Constrictors) Electronic/mercury blood pressure units Electrosurgical or electrocautery equipment Endoscopic video cameras/adapters/accessories/systems Eyemagnets for ophthalmic surgery Flash autoclaves Fracture tables Gloves Gowns Hypo/Hyper-thermia units Implants Insufflators Irrigation pumps Laparoscopes, laparoscopic telescopes, lap mayo trays or mayo stands Lasers Light sources Masks Medical cine fluoroscopy equipment Microscopes Needles OR Furniture Ring stands and positioning Equipment Robotic manipulators/surgical navigation systems Smoke Evacuators Sponges


Stretchers Sterilizers Steri-vac aeration cabinets Suction Surgical dermatomes or dermameshers and accessories Surgical Instruments (clamps, cutting, dissectors/elevators, endoscopes, forceps, graspers, needleholders, power equipment, probes/dilators, retractors, suction tips) Surgical nerve stimulators and accessories Surgical pneumatic or battery or electric saws or drills or pin drivers or accessories (craniotome drills, neurotome drills, orthopedic drills, surgical pneumatic drills) Pneumatic tourniquets Surgical power equipment sets or accessories (robotic arms, surgical robotics equipment, voice activated surgical systems) Surgical scalpels, knives, blades, trephines, or accessories Sutures Therapeutic healing or cooling blankets or drapes Tourniquets Trach Tube Ultrasound Video/cameras, recorders, printers Vascular sequential compression devices or tubing (venodynes) Vein harvest kits or systems (endoscopic vein harvesting equipment) X-ray fluoroscopy

* Detailed descriptions are available online from the Association for Surgical Technologists (2011) and the National Center for Competency Testing (2017).

Core or Optional

Competency A: Maintain the operating room environment according to surgical procedure


1. Ensure aseptic technique is maintained by all OR team members throughout the surgical procedure

Core

2. Maintain suction Core


3. Maintain temperature Core

4. Maintain lighting Core

5. Maintain furniture Core

Competency B: Provide the surgical team members with supplies required for the procedure


1. Obtain the appropriate sutures/needles/stapling devices Core

2. Prepare and cut suture materials as directed Core

3. Prepare drains, catheters, and tubing for use at the end of the case Core

Competency C: Assemble and test materials and specialty equipment during surgery


1. Assemble internal stapling devices Core

2. Verify with the surgeon and the circulating nurse the specific type and/or size of implantable devices

Core

3. Connect and activate drains to the suctioning device Core

4. Assemble and apply dressing material before transporting the patient to the recovery room Core

Competency D: Anticipate needs during surgery


1. Anticipate the need for retraction to facilitate proper operative exposure Core

2. Pass instruments and supplies as anticipated during surgery Core

3. Anticipate the need for and implement suctioning, sponging, and irrigation Core

4. Anticipate the need for various hemostatic agents based on the type of surgery Core

Competency E: Provide intraoperative assistance when delegated by a surgeon


1. Cauterize when directed by a surgeon Core

2. Assist in the placement of wound drains Core

3. Assist with skin closure Core

4. Assist with the application of casts, splints, braces, and similar devices Core


Competency F: Handle medications, solutions, and specimens appropriately


1. Verify and label medications and solutions at the sterile field intraoperatively Core

2. Report the total amount of medications and solutions used during the procedure Core

3. Handle specimens appropriately Core

Competency G: Perform closing sponge, needle, and instrument counts


1. Count and record sponges, needles, and instruments prior to procedure Core

2. Count closing sponges, needles, and instruments Core

3. Immediately report any discrepancies Core


JOB FUNCTION 3: Perform Postoperative Procedures and Room Turnover


KNOWLEDGE SKILLS TOOLS & TECHNOLOGIES

Hazardous materials, including sharps, blood borne pathogen safety, and radiological safety Unit procedure for placing used instruments in case cart Standard precautions and procedures

Organizational skills Sterile Technique Assure implants used in the case are communicated to the circulating nurse Applying dressings Connecting drains Connecting ostomy bags

Sterilization equipment Dressings Drains Ostomy bags

Core or Optional

Competency A: Conduct postoperative patient care


1. Remove surgical drapes from the patient Core

2. Cleanse the patient’s skin Core

3. Apply dressings, connect drains, and connect ostomy bag as needed Core

4. Assist with patient transfer from the operating table to the stretcher Core

5. Observe the patient postoperatively for any bleeding and relay status to the surgical team Core

6. Maintain the sterility of the back table and mayo stand until the patient leaves the room Core

Competency B: Dispose of waste


1. Reduce bioburden from instruments Core

2. Comply with standard precautions when removing and discarding drapes and waste Core

3. Dispose all sharps in compliance with standard precautions and procedures Core


Competency C: Perform room turnover after surgery


1. Disassemble the instruments for the decontamination and sterilization process Core

2. Return unused supplies and equipment to the designated location Core

3. Disinfect furniture and equipment Core

4. Remove/transport equipment Core

5. Dispose of waste Core

6. Wet vacuum/mop floor Core

7. Dress the bed Core

8. Inspect for room readiness Core


JOB FUNCTION 4: Assist Circulator



Age-related needs of the patient Basic Pharmacology Biopsychosocial needs of the patient Body mechanics Chart review Cultural Awareness Death and Dying Discharge Planning Health and Wellness Infection control Microbiology Patient identification Patient Rights Patient safety Documentation procedures

Post-operative care management Post-anesthesia care Patient catheterization Patient skin prep CPR Communication Skills Interpersonal Skills Problem Solving Skills Taking vital signs Identifying and managing complications Repositioning patient Transporting patient Transferring patient

Beepers Wheelchairs

Core or Optional

Competency A: Assist with/provide patient care


1. Assist with surgical preparation Core

2. Assist with placement of monitoring equipment Core

3. Assist with positioning of patient Core

4. Assist with/provide post procedure care Core

5. Assist with casting Core

6. Assist with patient transport Core

7. Assist with patient transfer Core

Competency B: Assist with supplies and equipment


1. Procure additional supplies as needed Core

2. Transport specimens Core

3. Pretest equipment for use as directed Core


JOB FUNCTION 5: Recognize and Demonstrate Knowledge of the Maintenance of Surgical Supplies/Equipment



Pathophysiology Microbiology Hazardous materials protocols Blood borne pathogen safety Radiological safety State and Federal Regulations/OSHA

Sterilization procedures

Various sterilizers Flash autoclaves Steri-vac aeration cabinets

Core or Optional

Competency A: Wash and decontaminate instruments


1. Washes instruments Core

2. Decontaminates instruments Core

Competency B: Ultrasound, milk, rinse, and dry instruments


1. Ultrasound instruments Core

2. Employs a milk bath for surgical instruments Core

3. Rinses surgical instruments Core

4. Dries surgical instruments Core

Competency C: Assemble Instrument Trays


1. Identify and locate instruments Core

2. Organize instruments in appropriate trays in appropriate organization Core


Competency D: Prepare for and operate sterilizers


1. Prepare for and operate a peracidity acid sterilizer Core

2. Prepare for and operate an ETO sterilizer Core

3. Prepare for and operate a steam sterilizer Core

4. Prepare for and operate a hydrogen peroxide plasma sterilizer Core

5. Prepare for and operate a dry heat sterilizer Core

6. Prepare for and operate a glutaraldehyde disinfection sterilization processor Core


JOB FUNCTION 6: Provide safe environment



Preoperative safety concerns Intraoperative safety concerns Postoperative safety concerns Electrical Safety Fire Safety Patient safety Hazardous materials protocols Handling of sharps Blood borne pathogen safety Radiological safety State and Federal Regulations/OSHA

Communication skills

Anaesthesia machine Pulse oximeter Imaging machine Hazardous materials disposal unit Sharps disposal unit

Core or Optional

Competency A: Maintain a safe preoperative environment


1. Initiate preventative and/or corrective actions in potentially hazardous preoperative situations

Core

2. Perform appropriate actions during a preoperative emergency Core

Competency B: Maintain a safe intraoperative environment


1. Initiate preventative and/or corrective actions in potentially hazardous intraoperative situations

Core

2. Perform appropriate actions during a intraoperative emergency Core

Competency C: Maintain a safe postoperative environment


1. Initiate preventative and/or corrective actions in potentially hazardous postoperative situations

Core

2. Perform appropriate actions during a postoperative emergency Core


Competency D: Practice precautions with critical equipment


1. Practice laser precautions Core

2. Practice electrical safety Core

3. Practice radiation safety Core

4. Handle compressed gas tanks and connections safely Core

Competency E: Practice general safety precautions


1. Practice/Adhere to universal precautions Core

2. Report/document unusual happenings Core

3. Remove defective equipment from service and report Core

4. Maintain room organization Core


JOB FUNCTION 7: Perform Departmental Responsibilities



Departmental Policies and Procedures Patient Rights

Computer skills (with database software, email software, graphics software, internet browsers, medical software [Electronic Medical Record EMR, PracticeWorks Systems Kodak WINOMS CS, Supply documentation software, surgery workflow communication software], Microsoft Office Suite.) Communication skills Interpersonal skills Teaching skills

Computers Database software Medical software

Core or Optional

Competency A: Receive/participate in department communications


1. Receive department communications Core

2. Participate in departmental communications Core

Competency B: Inventory supplies


1. Identify locations for all supplies Core

2. Count and record supplies Core


Competency C: Rotate supplies


1. Identify supplies’ levels of use Core

2. Rotate supplies to equalize levels of use Core

Competency D: Order supplies


1. Identify supplies in need of replacement Core

2. Order needed supplies or submit appropriate order request Core

Competency E: Use/update surgeon preference cards


1. Locate preference card for appropriate surgeon and procedure Core

2. Know how to identify, locate, and use all items on preference card Core

3. Identify potential inaccuracies Core

4. Identify potentially out of date equipment, new processes, or changed surgeon preferences Core

5. Report concerns so that preference card is appropriately updated Core

Competency F: Attend inter-/intra-departmental committees


1. Participate as a member in inter-/intra- departmental committees as appropriate Core

2. Record committee meeting schedules and duties Core

3. Attend scheduled committee meetings Core

Competency G: Maintain cleanliness of department


1. Identify and remedy problems with cleanliness of department Core

2. Monitor environmental features of operating theaters (such as positive pressure, air-conditioning systems and filters)

Core


JOB FUNCTION 8: Maintain Professional Responsibility



Professional behavior Stress management skills Online resources for maintaining professional competencies and certification

Core or Optional

Competency A: Maintain institutional competencies


1. Know required institutional competencies Core

2. Maintain competencies Core

3. Attain new competencies as required by institutional or professional changes Core

Competency B: Practice cost containment


1. Identify activities critical to cost containment Optional

2. Maintain practices that limit costs without sacrificing safety or level of outcomes Optional

Competency C: Attend/contribute to in-service classes


1. Identify and record content and schedule of in-service classes Core

2. Attend relevant in-service classes Core

3. Contribute to in-service classes as appropriate Core

Competency D: Evaluate new equipment


1. Identify newly obtained equipment Optional

2. Confirm proper functioning of newly obtained equipment Optional


Competency E: Precept new employees/students


1. Maintain supportive relationships with new surgical tech employees/students Core

2. Precept new surgical tech employees/students Core

3. Monitor and assess knowledge acquisition of new surgical tech employees/students Core

Competency F: Participate in performance improvement activities


1. Contribute to development of performance improvement plans for partially achieved competencies

Core

2. Engage in training or experiential activities as specified by performance improvement plans Core

3 8 R E F E R E N C E S

References

Association of Surgical Technologists, 2011. “Core Curriculum for Surgical Technology, 6th Edition.” on the Internet at http://www.ast.org/ (visited July 2018).

The National Board of Surgical Technology and Surgical Assisting, on the Internet at http://www.nbstsa.org/ (visited September 2017).

National Center for Competency Testing. 2017. “Tech in Surgery – Certified TS-C (NCCT) Detailed Test Plan. “On the Internet at https://www.ncctinc.com/ (visited July 2018).

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Surgical Technologists on the Internet at https://www.bls.gov/ooh/healthcare/surgical-technologists.htm (visited September 2017).

For a list of accredited programs for surgical technologists, visit the website for the Commission on Accreditation of Allied Health Education Programs, on the Internet at https://www.caahep.org/ (visited September 2017).

http://www.ast.org/

http://www.nbstsa.org/

https://www.ncctinc.com/Certifications/TSC.aspx

https://www.bls.gov/ooh/healthcare/surgical-technologists.htm

https://www.caahep.org/

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